A Brief Introduction to The Headache Classification...
Written by Damien Li | B.Phty (Hons), Headache Clinician
Headaches and Migraines are common and distressing conditions causing great disability and a vast decrease in quality of life. Up to 90% of people will experience at least one form of headache at one point in their lives. In Australia alone, statistics reveal that up to 16% of people are sufferers of severe migraines. For many headache and migraine sufferers, little to no relief has been found through traditional methods… So what are the Headache Clinicians at Refine Health able to offer?
Let’s start off with our classification for Headaches.
Headaches can be classified into two main categories. Primary and Secondary Headache. Primary Headache envelops conditions where no definitive structure can be identified to be the cause of the pain. This is the case for the most common headache types within the group one classification. Primary Headache accounts for roughly 90% of all headaches with the remaining 10% of headache types considered as Secondary headaches. Secondary Headaches consist of Headache types in which a known pathology or condition can be identified as the cause and source of the headache pain.
Figure 1. Headache Classification Flowchart
Within the Primary Headache category, there are three main types of headache; Tension-Type headache, Migraine, and a third group named the Trigeminal Autonomic Cephalalgias. Within the Secondary headache category, common types include Sinus-related headache, Cervico-genic headache, headaches caused by brain tumours or aneurysms, and medication-overdose headaches. By definition, if the cause is treated in a secondary headache, then the headache pain should resolve.
As of 2017, the International Headache Society has officially classified over 300 types of headaches. With so many different headache types, where do you begin to seek treatment let alone an accurate diagnosis?
Our Headache Clinicians at Refine Health are able to identify and classify which type of headache you may be suffering from through a detailed headache history and comprehensive assessment. Once an accurate classification has been established, treatment can commence based on whether or not your condition is identified as amenable and likely to respond to treatment.
Below are the most common headache diagnoses.
Common Headache Diagnoses
Tension-Type Headache or TTH accounts for up to 90% of primary headaches, making it the most common headache type by far. The duration can last anywhere from a few minutes to a few days and is described as a tight pressure around the head, usually across the temples and forehead. The severity can range from mild-moderate and is categorised further into 3 classifications depending on the frequency and chronicity.
Chronic Daily Headache
CDH closely mimics the symptoms of Tension-Type Headache, however the diagnosis is reached only when the following criteria is fulfilled; (1) pain that is experienced in the head, neck and face that is present for; (2) at least 15 days a month, for more than 3 months in a year. It is closely associated with medication overuse and differentiation of the conditions is crucial.
Severe and intense pain that is commonly unilateral (one-sided), Migraines are considered one of the most disabling and incapacitating disorders. Migraines account for up to 30% of all headache types. The characteristic signs of Migraine are the accompaniment of “associated features”, most notably, visual disturbances and aura, nausea and vomiting or sensitivity to light, smell or sound. Contrastingly, migraines can also present without aura and are classified as “Migraine without aura”.
Menstrual Migraine is considered when symptoms of classic Migraine occur in close relation with the menstrual cycle, either immediately before, during or after. Previous theories pointed to hormone level imbalances as the culprit, however, research has concluded definitively that this may not be the case. Results from numerous studies have identified no difference in hormone level changes in Menstrual Migraine sufferers and controls (Migraine-free individuals)1. MM is considered a Primary Headache disorder as the cause remains unknown. Menstrual Migraine is a serious condition that affects 60% of female migraine sufferers.
The most common Headache type within the third category of Primary Headaches, Cluster Headaches are also termed “Suicide Headaches” due to the extreme nature of pain that is experienced within an episode. The attacks occur in ‘clusters’ of minutes to hours at a time. Individuals can experience several episodes in a day. The symptoms of Cluster Headache are readily identifiable and distinguishable in comparison to the other headache types. Typically, Cluster Headache sufferers will experience alternating periods of remission (headache-free periods) and symptomatic periods lasting for months at a time.2
The importance of classification…
Classification and identification of your specific Headache type is vital in determining what treatment options may be available to you. Within the first assessment, your Headache Clinician will be able to identify your likely Headache diagnosis, the treatment options available for the identified condition, and, if determined that treatment is likely to succeed, a recommendation of a suitable plan for the treatment of your Headaches or Migraines.
More information on the conditions we treat can be found on our Headache and Migraine Services page. Alternatively, you can book a phone appointment with our Headache Clinicians at Refine Health on 3216 1330 for further information.
The entire classification can be found for free online, and can be accessed by following the link below.
For further reading on the topic, I would recommend highly a study published by Dr Dean Watson on the involvement of musculoskeletal structures in Primary Headache disorders titled, “Alternating Headache: C2-3 guilty or not?”. You can also access this article by clicking on the link below.
Current Treatment Options in Neurology, 2001, Vol 3, 2, pp 189-200
Gooriah, R., Buture, A., & Ahmed, F. (2015). Evidence-based treatments for cluster headache. Therapeutics And Clinical Risk Management, 1687. doi: 10.2147/tcrm.s94193 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4646474/